title: Dorsal column myelopathy following intrathecal chemotherapy for acute lymphoblastic leukemia.
abstract: OBJECTIVE/CONTEXT: To describe a distinctive clinical and radiographic pattern of myelopathy following intrathecal chemotherapy. Myelopathy is a rare complication of intrathecal chemotherapy used in the treatment of acute lymphoblastic leukemia (ALL). We present a 42-year-old female with T-cell ALL who developed a myelopathy primarily involving the dorsal columns.
  
  
  METHODS
  Case report and literature review.
  
  
  RESULTS
  Within 24 hours of an injection of intrathecal methotrexate, cytarabine, and hydrocortisone, the patient developed ascending lower limb numbness and balance difficulties progressing to the inability to ambulate. Clinical examination showed profound loss of lower limb proprioception and light touch sensation below T5, mild proximal limb weakness, but preserved pinprick and temperature sensation with intact bowel and bladder function. Initial thoracic and lumbar spine magnetic resonance imaging (MRI) at 1 week revealed no abnormalities. However, repeat imaging at 6 weeks showed abnormal signal in the posterior cord with sparing of the anterior and lateral columns, diffusely involving the lower cervical cord through the conus medullaris. Dermatomal somatosensory-evoked potential (DSEP) conduction abnormalities were consistent with thoracic myelopathy. An empiric trial of high-dose intravenous corticosteroids during inpatient rehabilitation more than 6 weeks later produced no significant clinical improvement.
  
  
  CONCLUSIONS
  Preferential and persistent dorsal column myelopathy is a distinctive clinical and radiographic presentation of a rare complication of intrathecal chemotherapy. The MRI abnormalities were initially absent, but evolved to consist of multi-level spinal cord T2 and STIR hyperintensity with regional gadolinium enhancement. DSEPs more accurately reflected the clinical level of spinal cord dysfunction.
authors.forename: Prathap Jacob
authors.initials: PJ
authors.lastname: Joseph
authors.forename: Maria Regina
authors.initials: MR
authors.lastname: Reyes
mesh_terms: D000328:Adult; D005073:Evoked Potentials, Somatosensory / Q000187:drug effects / Q000502:physiology; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D008279:Magnetic Resonance Imaging; D009431:Neural Conduction / Q000502:physiology; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000188:drug therapy*; D013118:Spinal Cord Diseases / Q000139:chemically induced* / Q000601:surgery; D013131:Spine / Q000473:pathology*
chemical_list: D007166:Immunosuppressive Agents
keywords: Chemotherapy, Intrathecal injections, Leukemia, Myelopathy, Spinal cord injuries, Somatosensory-evoked potential